Introduction
Neutropenic fever (NF) is the most common complication of anticancer therapy that results in unplanned admission. The MASCC (Multinational Association for Supportive Care in Cancer) index is a validated tool to assess a patient’s risk of developing complications associated with their NF presentation. Patients identified as low-risk have a <5% incidence of medical complications and can be safely treated with oral antibiotics and/or managed in an ambulatory setting1.
Methods
A WCMICS funded project has established an ambulatory program to manage low-risk NF patients at Peter MacCallum facilitated by a nurse coordinator. Low-risk NF patients are assessed for eligibility for oral antibiotics and suitability for the ambulatory program which utilises daily visits by Hospital-in-the-Home until neutrophil count recovery (>1.0 x 109 cells/L) then nurse-led clinic review.
Results
Twenty-five patients have been enrolled into the Peter Mac program over 12 months, data has been analysed on 16 patients. The median age is 57, with eight (67%) men and 10 (83%) solid tumors. Two (17%) patients required readmission for ongoing fevers. Median hospital LOS is 1.3 days (0.2 – 2.9) versus to 3.6 days (1.1 – 11.0), and median duration of intravenous antibiotics is < 1 day versus 3 days when compared with a historical cohort of low-risk NF patients. These reduced timeframes represent a saving of over $2000 per patient episode2 and $57,000 overall which exceeds the employment costs of the nurse coordinator (0.5 EFT). Patients and clinicians reported high levels of satisfaction with the program.
Conclusion
The ambulatory program represents a change in culture in the routine management of NF and the uptake while initially slow has shown very promising results. Ambulatory models of care are expected to become increasingly utilised and are likely to lead to significant health care cost savings whilst allowing the patients to remain at home during their neutropenic period.